A retrospective cohort study presented at SAWC Spring 2026 found that manual lymphatic drainage (MLD) was associated with shorter healing times and higher closure rates in patients with diabetic foot ulcers and lymphedema. While not statistically significant, results suggest that proactive edema management may improve outcomes, particularly in patients without concurrent leg ulcers.

Key Clinical Summary

• Manual lymphatic drainage (MLD) was associated with improved healing rates and shorter time to closure in patients with DFU and lymphedema.
• Patients receiving MLD demonstrated higher 12- and 20-week closure rates compared to those without therapy.
• The greatest benefit was observed in patients with DFU and lymphedema without concurrent leg ulcers.

Introduction

At the Symposium on Advanced Wound Care (SAWC) Spring 2026 in Charlotte, NC, investigators presented data examining the impact of lymphedema therapy on diabetic foot ulcer (DFU) healing. They found that addressing edema through manual lymphatic drainage (MLD) may improve healing outcomes. Given that peripheral edema is common in DFUs and current guidelines recommend assessment but lack specific treatment direction, this study provides important insights into potential therapeutic strategies.

Poster Highlights

In this retrospective cohort study, Kimberly Eby, FNP-BC, CWS; Brian Schmidt, DPM; Kourtney Noll, BHA; and Crystal Holmes, DPM, CWSP, evaluated healing outcomes in patients with diabetic foot ulcers and concurrent lymphedema over a 10-year period at a multidisciplinary wound center. Patients were categorized into 2 clinical groups: those with DFU and lymphedema alone (DFU/LE), and those with DFU, lymphedema, and an additional leg ulcer (DFU/LE/LU). Each group was further divided based on receipt of manual lymphatic drainage (MLD).¹

Among 20 patients treated with MLD, the mean time to wound healing was 22.5 weeks (range: 3.9–74 weeks). Closure rates reached 45% at 12 weeks and 65% at 20 weeks. In contrast, 21 patients who did not receive MLD had a longer mean healing time of 25.9 weeks (range: 3.6–77 weeks), with lower closure rates of 38% at 12 weeks and 57% at 20 weeks.¹

Notably, the most pronounced difference was observed in the DFU/LE subgroup. Patients receiving MLD in this group achieved a mean healing time of 13.6 weeks, compared to 25 weeks in those who did not receive MLD. Additionally, patients with DFU/LE/LU were more likely to receive lymphedema therapy than those with DFU/LE (p = 0.007).¹

Although differences between groups did not reach statistical significance, trends consistently favored improved outcomes with MLD.¹

Implications for Practice

These findings reinforce the importance of assessing and managing edema in patients with DFUs. While current guidelines recommend edema evaluation, this study supports more proactive intervention and highlights the need for standardized approaches to edema management in DFU care.

Conclusion

Lymphedema therapy may improve healing outcomes in patients with diabetic foot ulcers and concurrent lymphedema. Larger, prospective studies are needed to confirm these findings and inform clinical guidelines on edema management in DFUs.

Reference: 1. Eby K, Schmidt B, Noll K, Holmes C. Lymphedema Therapy Improves Outcomes in Patients with Concurrent Diabetic Foot Ulcer and Lymphedema. Presented at the Symposium on Advanced Wound Care Spring, April 2026.